Can Acupuncture Help Relieve RA?
Study shows acupuncture can lower levels of TNF-alpha in people with rheumatoid arthritis.
Poking needles under your skin doesn’t exactly sound soothing. But evidence is growing that acupuncture may help people with rheumatoid arthritis (RA). In a 2011 Chinese study in the Chinese Journal of Integrative Medicine, researchers at the China Academy of Chinese Medical Sciences divided 63 people with RA into two groups. One group had electro-acupuncture and the other traditional acupuncture. The study found that both types of acupuncture significantly lowered tumor necrosis factor-alpha (TNF-alpha) and vascular endothelial growth factor (VEGF). Electro-acupuncture was more effective in lowering VEGF than traditional acupuncture.
“Both TNF-alpha and VEGF are associated with chronic inflammation,” explains Nathan Wei, MD, director of the Arthritis Treatment Center in Frederick, Md. “In particular, TNF-alpha appears to play a pivotal role in the chronic inflammation and joint destruction that characterizes RA. That’s why so many of the biologic medications such as Enbrel [etnaercept], Humira [adalimumab] and Remicade [inflixumab] target TNF-alpha. And that’s why this study is so interesting: Acupuncture has been used to treat the pain of osteoarthritis, but this is one of the few articles I’ve seen where cytokine, or protein messengers, like TNF-alpha and VEGF have been affected in people with RA.”
Electro-acupuncture is much the same as traditional acupuncture. Both use the insertion of tiny needles into a person’s skin at any of the some 2,000 mapped pressure points along what are called meridians or channels. In Chinese terms, acupuncture restores the optimal flow of energy — called Qi (chee) — and balance in the body.
“Electro-acupuncture stimulates the needles with a mild electrical wave form,” says Kathleen Lumiere, DAOM, LAc, a doctor of Chinese Medicine, licensed acupuncturist and faculty member at Bastyr University in Seattle. “The intensity could be one-thousandth or one-millionth of the amount of energy in an incandescent light bulb so it’s a really mild stimulation. It’s the frequency of the stimulation that matters. Each frequency has distinct [biological and physical] effects.”
For this study, the frequency was likely low, says Lumiere, similar to the frequency of restorative, regenerating sleep, or delta waves, in a sense allowing the body to “believe” it’s in delta sleep.
“Electro-stimulation may have been more effective because it offers more consistent stimuli,” says Lumiere. “If a practitioner was tapping the needle two times a second, you might have a similar result but that would be exhausting.”
Electro-acupuncture also may have worked better because it stimulated a larger area, says Jeffrey I. Gold, PhD, director of the Pediatric Pain Management Clinic at Children’s Hospital in Los Angeles. Gold runs one of only two pediatric acupuncture programs in the United States, treating, among others, patients with juvenile idiopathic arthritis.
How acupuncture affects inflammatory markers like TNF-alpha is anyone’s guess. “No one has figured out one single mechanism for acupuncture’s effects,” says Gold. “But MRI studies show that an acupuncture site specifically induces a response in various portions of the brain. This gives it the possibility of affecting any organ or system that [interacts] with the brain. Acupuncture affects immunity, and the neurological, hormonal and psychological. It doesn’t only block pain signals.”
What Other Research Says
The China Academy researchers aren’t the first to show that acupuncture can lower inflammatory markers in people with RA. A 2008 Arthritis & Rheumatism review of eight acupuncture studies involving 536 patients with RA found that five studies reported a reduction in erythrocyte sedimentation rate (ESR), three saw a reduction in C-reactive protein (CRP), and one study described a significant drop in both. The studies lasted 11 weeks on average. ESR is a blood test that measures inflammation in the body. Levels of CRP, also measured by a blood test, also indicate inflammation. Six of the studies reported decreased pain, and four reported reduction in morning stiffness.
Acupuncture relieves pain by stimulating the releases of endorphins, the body’s own natural pain killers, says Jamie Starkey, LAc, the lead acupuncturist for the Center for Integrative Medicine, Cleveland Clinic in Cleveland. “We’re activating the peripheral nervous system, which then activates the central nervous system, so that the brain begins to release endorphins.”
And it works locally, she says, releasing a pain-relieving neurotransmitter called adenosine wherever the needles are inserted. “But why it happens, we are still not sure,” says Starkey.
In a 2008 German study published in Research in Complementary Medicine involving 44 patients with RA, patients either received auricular (ear) electro-acupuncture or autogenic (a form of relaxation) training once a week for six weeks. At study’s end, ESR was significantly reduced and TNF-alpha significantly increased compared to the relaxation group.
In this case, the TNF-alpha increase may have been a good thing, explains Gold: “TNF-alpha is not necessarily bad. It is an important part of our immune system. And when you treat RA, you don’t just treat blood markers. While an increase in TNF-alpha may be undesirable in some scenarios, it can actually be of benefit when placed in context with other factors. The answers may lie in understanding the balance between different players in the immune reaction, instead of focusing on a single factor.”
Taking the Acupuncture Route
“The more studies that come in showing the drop in inflammatory markers through acupuncture treatments, the more rheumatologists will take note,” says Starkey. In a 2010 Mayo Clinic survey, 54 percent of rheumatologists said they would recommend acupuncture as an adjunct treatments, she adds.
Here are some things to consider if you’re thinking of jumping on the acupuncture bandwagon:
Get picky. “Find an acupuncturist who comes highly recommended by your rheumatologist or physician, family friends, and colleagues so you know firsthand what their experience was like,” says Starkey. If you don’t know anyone to ask, check with The National Certification Commission for Acupuncture (www.nccaom.org). You can search on its site for a certified clinician in your area.
Acupuncturists also have to be licensed by their state medical board so you can check there as well. “Ideally, try to find someone who has experience working with RA patients,” says Starkey.
Some insurance companies cover acupuncture. Prices range, depending on your area, say Starkey, noting that in Cleveland prices are $60 to $200 per treatment.
Expect several treatments. “We tend to see substantial results within three to six treatments,” says Gold. But each patient responds differently and treatments vary depending on the stage of the disease, adds Starkey.
“The more chronic the condition, the more stubborn it is to treat. If we see you early on, there is a much better chance of improvement,” she says.
Understand the limits. Acupuncture doesn’t work on everyone, says Starkey: “In my clinical work, we see a 20 percent non-response rate. But more often than not, patients come in who have exhausted everything. Then they notice improvement.”
Try, try again. Acupuncture has many styles and practitioners. “If it doesn’t work right away, don’t dismiss the whole field of acupuncture,” says Gold. “Try a different style.”